- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $7,838.38
| Facility | | $1,000.00 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,363.66 / $1,363.66 / $1,363.66
| Facility | | $1,363.66 | $1,363.66 | $1,363.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.03 / $134.03 / $134.03
| Facility | AS | $134.03 | $134.03 | $134.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,065.05 / $1,350.00 / $1,780.12
| Facility | | $1,065.05 | $1,350.00 | $1,780.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.03 / $134.03 / $134.03
| Facility | AS | $134.03 | $134.03 | $134.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $4,616.00 / $17,636.00
| Facility | | $755.00 | $4,616.00 | $17,636.00 |